Graham Hospital Association
Organization Active NPI Rural Health Clinic/Center · Elmwood, IL
NPI 1093288797 · NPPES record last updated Jan 4, 2019
Key facts
- NPI
- 1093288797
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- GRAHAM HOSPITAL ASSOCIATION
- Practice address
- 1024 N. Magnolia St.
Elmwood, IL 61529 - Phone
- (309) 647-0201
- Fax
- (309) 647-8613
- NPI assigned
- Jan 4, 2019
- Organization subpart
- No
Authorized official
- Name
- Julie Reeder
- Title
- VP of Finance/Cfo
- Phone
- (309) 647-5240
Owners & managing parties with NPI records 3
-
Erin Elizabeth Bailey, M.D.
-
Kenneth R. Krock, MD
Other NPIs on the same Medicare enrollment 13
Other NPIs with the same Medicare PAC ID 14
Practitioners 128
-
Malinda M Babcock, APN
-
James Hlubocky, M.D.
-
Alison Lea Kerans, APN
-
Martin Kuntz III, MD
-
Farnaz Nani Moazzam, M.D.
-
Nathalie Snider, FNP-C
-
Susan Adams, RN, APN
-
Erin Elizabeth Bailey, M.D.
-
William Bailey, M.D.
-
Stephanie Barnes, APN
-
Joshua Bowers, M.D.
-
Bailey Jean Bucher, APN
-
Jessica Lynn Bugos, APRN
-
David Cao, MD
-
Andy C. Chiou, MD
-
Nancy J Crouse, CNP
-
Mark B Deyoung, MD
-
Rozana Hani Dwyer, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D2162398 | Graham Medical Group - Elmwood | Certificate of waiver | Feb 20, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IL
Rural health clinic certification: CCN 148603
- Legal name
- GRAHAM HOSPITAL ASSOCIATION
- Doing business as
- GRAHAM MEDICAL GROUP ELMWOOD
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Oct 23, 2019
- Last certification
- Oct 23, 2019
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 16, 1905 in IL
- Enrollment address
- 1024 N Magnolia St
Elmwood, IL 61529-9602 - Related CCNs
- 140001
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Allison Sours |
Corporate Officer |
Jan 6, 2026 | |
| W-2 Managing Employee |
Jan 5, 2026 | ||
| Operational/Managerial Control |
Jan 5, 2026 | ||
| William Carlberg |
Operational/Managerial Control |
Mar 4, 2019 | |
| Kenneth Krock |
Corporate Officer |
Mar 4, 2019 | |
| Operational/Managerial Control |
Mar 4, 2019 | ||
| Terry Moss |
Operational/Managerial Control |
Mar 4, 2019 | |
| Janis Blout |
Operational/Managerial Control |
Mar 1, 2019 | |
| Anne Hollis |
Corporate Director |
Jan 1, 2025 | |
| Erin Elizabeth Bailey |
Corporate Director |
Jul 1, 2025 | |
| Kevin Meade |
Operational/Managerial Control |
Mar 4, 2019 | |
| Michael Renner |
Operational/Managerial Control |
Mar 4, 2019 | |
| Patrick B Renick |
Corporate Officer |
Mar 4, 2019 | |
| Operational/Managerial Control |
Mar 4, 2019 | ||
| Sarah Keefer |
Corporate Director |
Jul 1, 2025 | |
| Julie Reeder |
Corporate Officer |
Mar 6, 2017 | |
| W-2 Managing Employee |
Mar 6, 2017 | ||
| Operational/Managerial Control |
Mar 6, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040510000873 | IL | Part B Supplier - Clinic/Group Practice | 2769375021 |
Receives reassigned benefits from 139 practitioners 13 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Galesburg, IL; Williamsfield, IL; Macomb, IL; Lewistown, IL; Glasford, IL; Farmington, IL; Elmwood, IL; Canton, IL |
| O20190124000462 | IL | Part a Provider - Rural Health Clinic | 2769375021 | Practice locations: Elmwood, IL |
National Provider Directory
Locations
1024 N Magnolia St
Elmwood, IL 61529
Phone (309) 742-6334
530 N Seminary St
Galesburg, IL 61401
1630 E Jackson St
Macomb, IL 61455
Phone (309) 647-5240
120 E Gale St
Williamsfield, IL 61489
Phone (309) 639-2233
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Multi-Specialty Clinic/Center | 261QM1300X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
1024 N. Magnolia St.
Elmwood, IL 61529
Mailing address
180 S Main St
Canton, IL 61520-2608
Phone (309) 647-0201
Other names
- Graham Medical Group Elmwood
Other providers in Elmwood, IL
- Gregory A. Dawson
- Mark B Deyoung
- Elmwood Chiropractic P.C.
- Elmwood District 322
- Pamela J Garner
- Kristen Jackson
- Cristy M Lane
- Local Health, Inc
- Mark C. Baylor, M.D.
- More Than Milk, LLC
All providers in Elmwood, IL · Rural Health Clinic/Center in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 4, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.